Healthcare Provider Details

I. General information

NPI: 1720402985
Provider Name (Legal Business Name): ERICA AMES ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2014
Last Update Date: 02/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 ROUTE 136
GREENSBURG PA
15601-6411
US

IV. Provider business mailing address

511 STONE VILLA CT APT 5A
GREENSBURG PA
15601-4576
US

V. Phone/Fax

Practice location:
  • Phone: 724-850-2607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005099
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: